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The Hair Loss Consultation

Hi, I believe I asked a question some months back but you only responded by asking me to come in for a consultation. So, let me try to get into specifics before considering coming in. I have been undergoing some stress lately and noticed thinning of my vertex. My hairline is completely unchanged… same as it has been since high school. I am also underweight for my height. Male, 28 years old 6’2″ 160-165 lbs. I have been underweight for the last 4-5 years. My average weight was 180 lbs in the past but have been eating less due to shortage of time and decreased appetite from work, plus I exercise 5-6 days a week. Also, my protein intake has fallen drastically.

I am contemplating whether I am experiencing MPB or Telogen Effluvium. Few months back I noticed a lot more shedding from the vertex area, mostly in the shower. I would pull at my hair and more than 4-5 strands would come out at a time and would not stop until I have pulled out an average of 10-15 strands. This happened every morning in the shower. It has somewhat slowed down, but now I am seeing some hairs come out that underwent miniaturization. Maybe I am experiencing a combo of both Telogen Effluvium and MPB. But has there been cases where men only experience balding in the vertex only?

My father is balding at the age of 59 (typical horseshoe). My mother’s side shows no signs of hairloss from anyone. He informed me that he experienced loss in the front first. If I inherited his baldness, would I follow his pattern?

Detailed feedback would be appreciated. Is consultation by appt only?

Yes, consultations are by appointment only. Your case, like many, are not as cut-and-dry as you’d like it to be, so it would be difficult to just make random assumptions about your hair loss without an exam. I’m not trying to “rope” you into coming in, but I’m also not trying to steer you in the wrong direction. This does require an exam, which can and should be done locally. When I see a patient for the first time (let’s say you, for example), I would plan on spending an hour with you, which gives me time to:

  • Get to know you
  • Listen to the problem you will be defining
  • Examine your scalp and hair in detail
  • Discuss a ‘plan of attack’ based upon a Master Plan we would setup to manage your hair loss problem

MPB can be limited to only the vertex (crown), or it may start in the front and progress backward. Genetic hair loss generally occurs in patterns (see Norwood Chart). Telogen effluvium, on the other hand, would be diffuse and not only limited to a patterned area.

If you’d like to setup a free consultation, you can either call my office at 800-NEW-HAIR or fill out the form on my site to Request Additional Info and someone from my staff will get in contact with you.


2007-12-20 09:55:05The Hair Loss Consultation

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Hair Transplant Surgery Review of What is Possible for Norwood 5 Balding Pattern.

This is a review of a hair transplant surgery at the New Hair Institute and what is possible for a Norwood 5 patient.
This patient had two procedures totaling 4774 grafts. He still has about 2000 to 3000 graft extra reserve if he has further hair loss on his crown area where there is significant miniaturization. He should stay on Propecia/finasteride to slow down the crown hair loss which is an almost certainty considering the amount of miniaturization that he has in the crown. Needless to say a very happy patient!

After photos – taken September, 2006:

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I’ve Been Taking Half a Propecia Daily Because It Caused Shoulder and Chest Pain on My Left Side

I am 29 and I have been treating hair loss with minoxidil for approximately 6 years with an unfortunate gradual progression in thinning.

I started taking propecia in addition to the above about 2 months ago. When I first began treatment, after a few days on the recommended 1mg dosage, I developed a pain in my left shoulder/arm and also in my chest area (again mostly on my left hand side). I also suffered from less semen being produced. I stopped treatment for a few days and the pain subsided.

Determined to treat my hair loss I tried again with the propecia but taking just half (0.5mg) a tablet a day. After a day or two there were hints of this shoulder pain returning but it then subsided and I have been able to continue with treatment at 0.5mg a day with virtually no problems (I still have decreased semen production but not to the extent that it causes any problems).

My question is: having been taking a half dose for these 2 months would it be worthwhile trying to go up to the recommended 1mg again? Is there a chance that my body may have adapted to the use of finasteride and could cope with the increase or would it be wiser to remain on the 0.5mg dosage (given that i still have the side effect of reduced seminal fluid) and hope that it has some positive effects upon my hair loss situation?

A half a dose will work about 80% as well as a full dose. I would try one more time at the full dose but if the pain comes back, stick to the half dose. Have a doctor check out your chest and shoulder pain.

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The Value of Double vs Single Follicular Unit Technique

I have seen on the internet, the promotion of a double FU technique. Can you explain it to me and tell me about the value of a double follicular unit technique.

Follicular units (FUs) have one, two, three or four hairs each. When they are placed in the recipient area, they are graded in the frontal hairline (FUs with one hair each up front). There are times when the doctor wants to have more two or three hair grafts and the donor area yielded too many one hair grafts (common in Asian patients). In this situation, two single hair grafts (or one single and one double hair graft) are placed into a single recipient site and that is what is referred to as a ‘double FU technique’.

A bald man may get between 250-500 single haired FUs at the leading edge to create a soft, transitional hairline zone. All other FUs should contain more than one hair each to produce value. As each person has a different distribution of single hair FUs out of a harvested strip, the number of single hair FUs are determined by the anatomy of the patient (not the surgeon). So to get more than a single hair FU to place behind the leading edge transition zone, one might have to double up the single hair FUs to get reasonable bulk. More bulk can be obtained by putting a single hair FU with a two-hair FU to create a three-hair FU so that there is a way for the surgeon to determine and control the bulk of the hair that is transplanted.


2007-09-28 15:33:50The Value of Double vs Single Follicular Unit Technique

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Government Study Comparing Finasteride, Dutasteride, and Placebo

https://clinicaltrials.gov/ct2/show/results/NCT01231607?show_locs=Y§=X430125&view=results#othr

 

ClinicalTrials.gov Identifier: NCT01231607

Recruitment Status : Completed

First Posted : November 1, 2010
Results First Posted : October 4, 2012
Last Update Posted : August 10, 2018

Sponsor: GlaxoSmithKline

Dr. Rassman’s Comment: I want to call your attention to the chart below, which discusses sexual side-effects between these medications and the placebo. To find out the real incidence of the Libido and Erectile Dysfunction problems from this study, you must subtract the placebo numbers. If this is true, the incidence is relatively low.
Government Study Comparing Finasteride, Dutasteride, and Placebo
Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement, lead to unreliable or uninterpretable data.

 

 

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Thickness of Transplanted Hair

Why is the hair from the second transplant just one year ago finer than the hair from my first hair transplant 18 years ago?

The new hair compared to your transplanted hair from 18 years ago should be the same as the hair in the back of your head. Check each area with a micrometer and see if they match.


2018-09-14 08:56:00Thickness of Transplanted Hair

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Gray Hair, Changing Diameter?

When hair turns gray, does the diameter change?

From my clinical experience I can tell you that the gray grafts appear thicker than the non-gray grafts. This is evident in the single hair grafts. Now that you sent me this question, I should measure the gray hair diameter and compare it with the non-gray hair diameter over the next few weeks and maybe get back to you with a small research study. Thanks for the great question!

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I think that I was taken to the cleaners by this doctor? (photo)

He did 1500 grafts in just 40 minutes. I counted only 700 or so. What do you think?

The surgeon must make a surgical record of the actual graft count. Ask for that surgical record, as you are entitled to it. In 40 minutes for 1500 grafts, I would say that is ‘god’s speed’. Was the surgeon some deity? The wounds look larger than I would make them. I would need more information about the surgery such as strip or FUE? If it were a strip, the dissection would not have been very careful and in 40 minutes, I believe you may have been, as you said, ‘taken to the cleaners’.

1500 grafts in 40 minutes

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Growing Hair from Body Fluid Injections to the Scalp?

I heard of a technique where your own bodily fluid is injected into the male pattern balding spot and is supposed to grow hair. Can you tell me what you know about this treatment? Is it for real, is it permanent, is it for the frontal part of the scalp etc.?

I don’t know of injecting body fluid (???) in your scalp to grow hair… but I do know some clinics offer platelet rich plasma (PRP) into the scalp in hopes it will provide faster healing after a hair transplant. Some dentists use it for faster healing after a dental procedure. I asked a few dentist friends, one of which is a professor at UCSF, and she believes PRP is controversial even in the dental field.

In the end, this method has never really been proven to grow hair on a bald scalp. If anyone can find a well controlled study for hair growth from PRP, please let me know. Some doctors charge hundreds or thousands of dollars for PRP, but I remain a bit skeptical. The patients we’ve viewed in the office haven’t had the results their doctors promised.